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Tennessee rates for HCPCS L8030

Breast prosthesis, silicone or equal, without integral adhesive

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$168.18 / $171.48 / $171.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.18 / $171.48 / $294.58
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$395.80 / $395.80 / $395.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.82 / $356.22 / $356.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$202.41 / $296.00 / $296.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.08 / $216.08 / $296.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$633.44 / $1,976.32 / $2,177.31
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,200.21 / $2,200.21 / $2,911.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.63 / $197.46 / $300.58